Pilot Test of a Pain Management Intervention for Individuals with Axis I Disorders

Abstract:

The majority of chronic pain sufferers also experience concurrent mental health problems; however, there is little research examining treatments developed specifically for this population. The purpose of this study was to pilot test a new, six-session group intervention designed specifically for adults with both chronic pain and Axis I psychiatric diagnoses. The effectiveness of the intervention was investigated using a quantitative multiple case study design, with a treatment group (n = 9) and a wait-list control group (n = 6) of patients at a nonprofit community health facility for underinsured and uninsured individuals. Time series data from 12 time points were gathered from individual cases and were analyzed using Simulated Modeling Analysis procedures (SMA; Borckardt et al., 2008). It was hypothesized that compared with the pre-intervention phase, the intervention phase would be associated with lower perceived levels of pain severity, negative pain-related beliefs, and negative mood, as well as higher levels of self-efficacy for pain management. It also was hypothesized that the above effects would not be
observed among control group participants. As with other psychosocial treatments for pain, the hypothesized effects did not emerge consistently across participants. The strongest support for hypotheses was with respect to levels of perceived pain and disability: One-third of treatment group participants had statistically significant reductions on these variables, whereas virtually no such effects were observed among control group participants. Results also indicated that one-third of treatment group participants had statistically significant increases in perceived pain. Informal analysis of data indicated that treatment benefits were more likely to be observed among those who were (a) engaged in sessions, (b) parents, and (c) caregivers for friends or family members. Limitations of the study included problems with participant compliance, including lateness to sessions, missed sessions, and incomplete or missing surveys. Future studies of treatment for co-morbid pain and mental disorders should (a) investigate the role of readiness to change in treatment outcomes, (b) develop ways to increase compliance, (c) conduct follow-up assessments to look for delayed improvement, (d) measure temporal relationships among outcome variables, (e) measure pain severity and suffering separately, and (f) assess pain-related acceptance.